Dental Office Application With Sliding Scale In Clark
Category:
State:
Multi-State
County:
Clark
Control #:
US-00413-1
Format:
Word;
Rich Text
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Description
This form is an Employment Application. The form provides that applications are considered without regard to race, color, religion, or veteran status.
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Many free and slidingscale options are available to help NYC residents access highquality dental services regardless of cost. The sliding fee scale program is available to uninsured patients who are unable to pay for medically necessary services at certain Northwell Health clinics.Sliding scale based on income, Medicaid only accepted for adult emergencies. Thurs 8am5pm, Fri 8am2pm, closed Saturdays. In order to qualify you will need to meet the following requirements listed below and fill out the sliding scale fee application. 8867. 2730 SW Moody Ave , Portland, 97201. Procedures for patients requiring dental implants are provided. All dental products will be provided on a sliding fee scale based on household income. ______(initial). Please bring this form with you on the day of your appointment. This information may need to be updated in the future.